different narratives in different doctor patient relationships

8/7/2019 Different Narratives In Different Doctor Patient Relationships

1/20

Different narratives in different

doctor-patient relationships

08-02-2011Annette Sofie Davidsen, MD, [email protected]

1


2/20

Family practice

` Carachterized by:

` All sorts of problems

` Great part of workload is made up of mental disorder

` Long-extended knowledge of patients

` Knowledge of illness story and family story

08-02-20112 Annette Sofie Davidsen, MD, [email protected]


3/20

Aim of study


3

` To explore which narratives family physicians told aboutpatients with psychological problems or mental disorder


4/20

Narratives

08-02-20114 Annette Sofie Davidsen, MD, [email protected]

` Increasing interest in narratives across many disciplinessince the 1980s

` The narrative turn


5/20

The narrative turn


5

` In psychology

` Bruner, J. (1986).Actual Minds, PossibleWorlds.Cambridge, Mass.:Harvard University Press.

` Bruner, J. (1990).Acts of Meaning.Cambridge, Mass.: HarvardUniversity Press.

` Sarbin,T. R. (1986).Narrative psychology, the storied nature ofhuman conduct. New York: Praeger.

`

Polkinghorne, D. E. (1988).N

arrative Knowing and the HumanSciences. Albany, N.Y.: State University of New York Press.


6/20

The narrative turn


6

` In psychotherapy

` Schafer, R. (1980). Narration in the Psychoanalytic Dialog.Critical Inquiry, 7, 29-53.

` Spence, D. P. (1982). NarrativeTruth andTheoreticalTruth.

Psychoanalytic Quarterly, 51, 43-69.` Angus, L. & Kagan, F. (2007). Empathic Relational Bonds and

Personal Agency in Psychotherapy: Implications forPsychotherapy Supervision, Practice, and Research.Psychotherapy:Theory, Research, Practice and Training, 44, 371-377.

` McLeod, J. (1999). A narrative social constructionist approachto therapeutic empathy. Counselling Psychotherapy Quarterly, 12,377-394.

` Schafer, R. (1992). Retelling a life:Narration and Dialogue inPsychoanalysis. New York: Basic Books.


7/20

The therapist is never a neutral mirror


7

` The story is always created in an interplay betweentherapist and patient

` In psychotherapy

` and

` In family practice


8/20


8

` Consultations in family practice contain manypsychotherapeutic elements


9/20

Method


9

` In-depth semi-structured interviews with 14 familyphysicians

` Invited to tell patient stories

` Narrative analysis of interviews

` Descriptive

` Interpretive


10/20

Results


10

` Different participants told completely different stories` Different themes

` Different narrative styles

` Four types` Stories with detailed description of patients situation

` Stories about emotions and relationships

` Stories about irritation

` Stories about categorization and biomedical perspectives


11/20


11

` Each participant told the same type of

narrative the same narrative style

through the entire interview


12/20

Stories with detailed description of

patients situation


12

` Easy and natural to tell stories

` Detailed stories

` Deep knowledge

` Own reflections

` Engagement


13/20


14/20

Stories about emotions and relationships


14

` Patients emotional reaction and the relationship had acreative influence on the story

` And I think, then she experiences a relation between two

human beings. That I think is important. This is the way wework in the dialogue, to get some, what could I call it, some

feelings on the table which the patient has to tackle, and I

have to tackle, and then we must see how we manage. The

relation between, really, what happens just between us.


15/20

Stories about irritation


15

` Tired of patients` Stories created by irritation

` Not interested in hearing incoherent stories

` To be honest I had actually become somewhat tired of her, so I

simply could not stand it any more


16/20


16

Family physician: Some can be enormously irritating. She

made me well, she was really irritating, unctuous, and would

tell of all these horrible things she had and how it hurt here

and there.

Interviewer: but was that someone you could ask to tell herlife story to get another view of her?

Family physician: no, she was too irritating, too peculiar. Im

damned if I think so. It must be some who who you are

somewhat interested in hearing about. I was not interested in

hearing about her.


17/20

Stories about categorization and biomedical

perspectives


17

` Much shorter` About

` Biomedical diagnoses

` Prescription

` Sick leave

` Medical certificates

` Reluctant to tell patient stories

` Did not know details


18/20

Interpretation of results


18

` Family physicians have different theoretical frames ofreference for understanding patients

` Different consultation styles

` Different discourses of understanding

` Different professional positioning

` Manifests itself through the style of narratives they tell

about their patients` The style is global and consistent


19/20

Implications


19

` Training a narrative understanding could increase familyphysicians psychological understanding of patients.

` The conditions in family practice are suitable for this

approach


20/20


20

different narratives in different doctor patient relationships

Documents